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History: Multiple case reports of fifth metatarsal intramedullary fixation stress symptomatic hardware with screw head impingement on the cuboid. Methods: For 20 weightbearing foot computed tomographs, an automated device was used to simulate fifth MT screw fixation in the desired direction down the shaft and with a 7-mm screw head. In three dimensions, the closest distance from the simulated ideal trajectory to the cuboid was measured. In three dimensions, a simulated screw head was then transformed from the proximal tip of the metatarsal distally into the metatarsal until the cuboid was essentially free from the cuboid. Conclusion: The ideal guidewire placement for the fifth MT intracorpore fixation is right against the cuboid. If the screw is not countersunk, approximately 95% of patients will have cuboid impingement.
Source link: https://doi.org/10.1177/10711007221084624
BACKGROUND: Arthritis of the metatarsophalangeal joint is characterized by the absence of MTP joint mobility and pain. The aim was to evaluate the sagittal kinematics and articulating contact characteristics of four different first metatarsal head designs of an MTP joint implant using a cadaveric model. Methods: Six cadaveric feet were each fitted with a single modular first MTP joint total arthroplasty. The native joint was compared to 4 separate reconstructed cases in the study. Each rebuilt joint used a different metatarsal-head-component while reusing the same phalangeal unit to compare the 4 alternate metatarsal head designs. Results: All reconstructed joints had greater ROM compared to the original joint. All reconstructed joints had contact areas lower than the original ones. Conclusions: ROM was shown to be more suitable for the more anatomically developed metatarsal head, in this research, although contact properties did not change among different designs.
Source link: https://doi.org/10.1177/1071100713483096
When the osteotomy is combined with adductor tenotomy, an elevated risk of up to 40% of avascular necrosis diagnosed radiographically has been reported. 38 consecutive patients were randomized to Chevron osteotomy alone or Chevron osteotomy with adductor tenotomy in this prospective research. In a patient treated with Chevron osteotomy alone, three defects were discovered, one defect was discovered in a patient treated with Chevron osteotomy and adductor tenotomy. Therefore, Chevron osteotomy is a safe therapy for hallux valgus treated with adductor tenotomy without increasing the risk of circulatory disruption.
Source link: https://doi.org/10.1177/107110079201300305
Is the disruption of muscle balance at the first metatarsophalangeal joint involved in the hallux val complex's pathogenesis? What is the connection between dynamic plantar load delivery and pain in the ball of the foot's ball? Both the force under the toe and the medial deviation of the first metatarsal head were measured on preoperative patients and controls when pressing the hallux down. In other words, the foot widened, and we could show with statistical certainty that when the subjects with hallux valgus push the first metatarsal head with the grand toe on the ground, the first metatarsal head advanced in medial direction. The greater the valgus deviation of the hallux, the more pronounced the toe flexors' impact, and the more valgus deviation of the hallux, the less maximal flexion force it can use.
Source link: https://doi.org/10.1177/107110079201300905
In a large number of patients, there has been no record of avascular necrosis of the metatarsal head following distal first metatarsal osteotomy combined with adductor tendon release. Of 82 consecutive procedures in 64 patients performed between 1986 and 1988, 42 patients were enrolled for clinical and radiographic examination. At 4. 2 years' follow-up, the patient was asymptomatic, two with infections, one hallux varus, and no nonunions were found among the remaining patients.
Source link: https://doi.org/10.1177/107110079401500201
In the majority of cases, the lateral head of the flexor hallucis brevis by fibular sesamoidectomy was used to determine clinically relevant avascular necrosis of the first metatarsal head, distal metatarsal neck junction, and the emergence of the adductor hallucis muscle, the lateral capsulosesamoid ligament, and the first metatarsal osteotomy of the first metatarsal head. There were no patients with persistent radiographic changes indicating avascular necrosis in patients who complained of pain. We found out from the radiographic and clinical evidence that if the primary blood supply to the capsule and head of the metatarsal is preserved, an extensive lateral release along with a distal metatarsal osteotomy of the chevron configuration are unlikely to cause clinically significant avascular necrosis of the first metatarsal head.
Source link: https://doi.org/10.1177/107110079401500601
The forefoot in rheumatoid arthritis by surgical reduction of all metatarsal heads in combination with a resection arthroplasty of the first metatarsal joint produced outstanding and fair results in 20 of 26 cases, with satisfactory and fair results in 6 of 26 cases. While minimal metatarsal resection, single excessive length, or plantar spike formation revealed pressure peaks in the metatarsal region, the metatarsal zone's toe function is more effective. In 24 of 26 cases, metatarsal head resection provided pain relief and deformities, as well as allowing patients to wear normal shoes.
Source link: https://doi.org/10.1177/107110079701800703
Introduction: Background: The first metatarsophalangeal arthritis stages have traditionally been treated with either arthroplasties or arthrodesis. The results of arthrodesis are superior to those of metallic joint replacement, according to studies; however, complications and suboptimal outcomes in active patients with the first MTP joint persist. This article discusses the results of patients with advanced MTP arthritis who underwent metallic resurfacing of the MTP joint on the metatarsal side of the MTP joint. Methods: From 2005 to 2006, 26 patients with stage II or III hallux rigidus underwent resurfacing with the HemiCAP® implant, and Ankle Society and Short Form 36 Health Survey results were compared. Mean passive ROM increased from 28. 0 to 66. 3 degrees in Mean's. Mean RAND's physical component score increased dramatically from 66. 7 to 90. 6 percent, according to a survey by Mean RAND SF-36 physical component scores, which went from 66. 7 to 90. 6.
Source link: https://doi.org/10.1177/1071100713478930
Purpose: To compare the clinical results of the osteochondral autograft transfer system with those of subchondral drilling for the treatment of osteochondral defects of the first metatarsal head. Methods: The authors retrospectively reviewed 24 cases of osteochondral abnormalities of the first metatarsal head treated surgically; 14 patients underwent subchondral drilling; 10 patients were treated with the osteochondral autograft transfer system; and 10 were treated with the osteochondral autograft transfer device; In group B, there was no correlation between defect size and subchondral cyst with medical outcomes. Conclusion: The osteochondral autograft transfer device may be used as a treatment of choice for osteochondral defects of the first metatarsophalangeal joint, or if a subchondral cyst exists.
Source link: https://doi.org/10.1177/0363546512449292
This paper compares the potential benefit of fifth metatarsal head resection versus traditional conservative therapy of plantar ulcers in diabetic patients. Patients who underwent a fifth metatarsal head resection recovered much faster. The findings of this research show that fifth metatarsal head resection is a potentially safe treatment in patients at risk of ulceration and reulceration.
Source link: https://doi.org/10.7547/0950353
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